Provider Demographics
NPI:1609856301
Name:LEAHY, CINDY M (DO)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:M
Last Name:LEAHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W MEYER RD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3653
Mailing Address - Country:US
Mailing Address - Phone:636-698-6266
Mailing Address - Fax:636-698-6222
Practice Address - Street 1:1502 W MEYER RD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-698-6266
Practice Address - Fax:636-698-6222
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO080143867OtherMEDICARE RAILROAD
MOCD6059OtherRR GROUP
MO248305021Medicaid
MO000010002Medicare PIN
G09067Medicare UPIN